Food Insecurity, Food Assistance, and Psychological Distress among University Students: Cross-Sectional Survey Western Australia, 2020.

University students have been identified as a population sub-group vulnerable to food insecurity. This vulnerability increased in 2020 due to the COVID-19 pandemic. This study aimed to assess factors associated with food insecurity among university students and the differences between students with and without children. A cross-sectional survey of (n = 213) students attending one university in Western Australia measured food insecurity, psychological distress, and socio-demographic characteristics. Logistic regression analyses were conducted to identify factors associated with food insecurity. Forty-eight percent of students who responded to the survey had experienced food insecurity in 2020. International students who were studying in Australia were nine times more likely to experience food insecurity than domestic students (AOR = 9.13; 95% CI = 2.32-35.97). International students with children were more likely to experience food insecurity than international students without children (p < 0.001) and domestic students with (p < 0.001) or without children (p < 0.001). For each unit increase in depression level, the likelihood of experiencing food insecurity increased (AOR = 1.62; 95% CI = 1.12-2.33). Findings show a higher prevalence of food insecurity among international university students and students with children during the COVID-19 pandemic and that food insecurity was associated with higher levels of psychological distress. These findings highlight the need for targeted interventions to mitigate the risk of food insecurity among Australian university students, particularly among international students, students with children, and those experiencing psychological distress.

Preparing Students for Post-COVID Nursing Careers: The Value of International Clinical Placements.

BACKGROUND: Prior to the coronavirus disease 2019 (COVID-19) pandemic, international clinical placements (ICPs) for nursing students were used to build cultural humility and global awareness. This study explored the influence of ICPs on nursing students' career planning and views of the nursing role; the findings were considered against the evolving pandemic context. METHOD: A qualitative, descriptive longitudinal study was conducted with 25 preregistration nursing students who participated in an international placement. Semistructured individual interview data were examined using thematic analysis. RESULTS: Participants were interested in patient equity and empowerment, high acuity and variety, health policy, and primary care. Participants developed resilience and nursing confidence. They saw the effects of poor health equity and health policy decisions on population health. CONCLUSION: ICPs expanded participants' understanding of global interconnectedness and also identified new career possibilities. Postpandemic, nursing education should continue to maintain a global focus on health. [J Nurs Educ. 2023;62(4):207-214.].

Professional Interpreter Services and the Impact on Hospital Care Outcomes: An Integrative Review of Literature.

Migration patterns have rapidly changed in Australia and elsewhere, which have contributed to increasingly culturally and linguistically diverse societies. This requires healthcare sectors to provide professional interpreter services for patients with a language barrier to eliminate healthcare disparities. This integrative review aimed to investigate the impact of professional interpreter services on hospital care outcomes and the associated cost of service provision. A systematic search of five databases was conducted for peer-reviewed articles from January 1996 to December 2020. Data were extracted for the hospital setting, intervention, population, study design, outcomes and key findings. Following the PRISMA guidelines, full-text screening identified 37 articles that were analysed and included. Communication quality, hospital care outcomes and hospital costs were the three main themes identified. Closing the language gap should be a primary consideration to prevent adverse events that affect patient safety and the standard of care in hospitals. The findings of this review indicate the provision of professional interpreter services can enhance hospital care for linguistically diverse patients by improving patient-provider communication. To gain insight into the changing patterns on the outcomes of medical care, further research requires efforts by the hospital administrative system to document complete records of service usage.

Gynaecological Cancers in India: The Less Heard Perspectives of Healthcare Providers.

There has been mounting evidence on the role of healthcare providers in chronic illnesses such as cancer. The specific complexities in their roles to enable health are less heard. Gynaecological cancers have several undercurrents beyond the obvious. Semi-structured interviews were conducted with healthcare providers in Southern India (n = 35) and the data presented in this article were collected as a part of a larger study on the role of communication in the management of gynaecological cancers in India. Thematic analysis of the qualitative data provided information on the providers' perspectives of gynaecological cancers. Patient numbers, cost, time, cultural norms, context, and institutional constraints in cancer care provision are just some of the factors impacting care provision. Healthcare providers are typically acknowledged for the criticality of their roles in the continuum of care. However, our research suggests that the psychological harm and challenges they themselves may face in providing that care are severely neglected. Through listening to healthcare provider voices, clear solutions emerge to better support the practice of those who are responsible for cancer care.

Males' Lived Experience with Self-Perceived Pornography Addiction: A Qualitative Study of Problematic Porn Use.

The positive impact of pornography use has been demonstrated; however, most research points towards problematic, compulsive, or excessive engagement with pornography and associated adverse effects on well-being. However, results remain inconclusive and qualitative research capturing perspectives of affected people is scarce. This phenomenological study aimed to explore the perspective and lived experience of males with a self-reported addiction to pornography. Semi-structured in-depth interviews with 13 males aged between 21 and 66 years from Australia and the USA were conducted. A thematic analysis of the transcripts was undertaken, resulting in the identification of four themes. The interviews explored the participants' reasoning for determining themselves as porn addicts, investigated patterns of use, examined the perceived multifaceted impacts of pornography use, illustrated applied individual strategies to overcome the addiction, and proposed interventions helping to inform future recommendations. Experiences and perceptions of pornography addiction were consistently depicted as problematic and harmful. Most participants described an inability to stop their consumption despite experiencing adverse effects. Commonly reported was a gradual increase in the use of and consumption of new or more shocking content. Consumption of content was outlined as an escape or coping mechanism for negative emotions or boredom. Participants reported a variety of applied strategies to manage their addiction and suggested recommendations. Investigation into strategies for the identification of problematic pornography use, its conceptualization, associated health outcomes, and effective preventative and interventional strategies are required to provide academic consistency, support those negatively affected by pornography, and achieve increased public awareness of the issue.

"I don't think marijuana counts as a drug": Drug & alcohol use amongst South Sudanese youth in Australia.

AIMS: To understand alcohol and other drug (AOD) use and its impact among South Sudanese youth in Melbourne, Australia. METHODS: This qualitative exploratory study was underpinned by the psychosocial conceptual framework. We undertook semi-structured interviews with 23 South Sudanese youth aged 14-21 years to explore attitudes and potential harms of AOD use. We also undertook focus groups with these participants and a focus group of 11 South Sudanese community elders and parents. Feedback on results was obtained through two forums with community members. The data collected were analyzed using thematic analysis. RESULTS: The participants revealed that AOD use was common, specifically the use of cannabis. The participants believed that there was a lack of basic understanding of the potential harm of cannabis use. The results also highlighted that the community was unaware how the use of drugs and alcohol can contribute and exacerbate poor mental health. Cannabis was a regular drug of choice used by young South Sudanese in this study. It was used daily as a coping mechanism both for stress and for undiagnosed mental health. CONCLUSION: The results of this study indicate increased potential harm for South Sudanese youth from AOD use. Of concern was a lack of diagnosis and treatment for mental health wellbeing due to the beliefs around AOD use. Without targeted interventions this has significant implications for the South Sudanese community and the young people affected. The significance of these findings may assist in the delivery of AOD treatment and improve health education for refugee youth.

Intergenerational conflict among resettled South Sudanese in Australia.

South Sudanese families have faced many hardships in the process of acculturation to Australian society. This has led to rapid family breakdown amongst refugees from South Sudan who live in Melbourne, Australia, and has created tension between families, the wider South Sudanese community, and authorities. This qualitative study explores how shifting dynamics of religious faith, the concept of family and cultural values impacts South Sudanese families and young people. The study consisted of 23 semi-structured interviews, three focus groups and two feedback forums, gathering data from South Sudanese youth aged 14 to 21 years, social workers, elders and parents from the South Sudanese community. Several themes were identified including the impact of intergenerational conflict, coping with new freedoms in Australia, the associated tensions these freedoms create within the South Sudanese community, and young people's conflict with religion. The patriarchal system that underpins the family structure of the South Sudanese culture is under significant strain as women and children are becoming aware of their rights, resulting in friction between men and women, parents and children. Male elders believed the embracing of freedom by women and children was at the core of family breakdown, leading to cultural erosion, and was the root of the problems experienced by the youth. The church as a traditional meeting place and a centre point for social inclusion within the South Sudanese community remains relevant as an important factor in social networking for parents and elders but lacks relevance for many South Sudanese youth.

Peer Mentoring Programs for Culturally and Linguistically Diverse Refugee and Migrant Women: An Integrative Review.

Refugee and migrant women experience personal, cultural and structural challenges as they adapt to new lives in host countries. Peer mentoring programs are used to facilitate resettlement, build empowerment and improve job-readiness for refugee and migrant women; however, the effectiveness of these programs is not well understood. A systematic search of five databases, plus grey literature from January 2005 to December 2020, was undertaken, resulting in 12 articles. A narrative synthesis using thematic analysis identified the key components and outcomes of effective programs. Most mentoring programs were co-designed with community-based service providers, using participatory approaches to ensure cultural acceptability. Communication and sharing were facilitated using workshops and individual in-person or telephone mentoring. The training and support of mentors was critical. However, differences in expectations between mentors and mentees at times resulted in attrition. Qualitative evaluation revealed enhanced social support, greater empowerment and confidence for the women. There was improved access to the social determinants of health such as education, but limited success in obtaining employment. Mentoring programs can enhance refugee and migrant women's wellbeing and social connectedness in resettlement contexts. However, it is unclear whether these benefits can be sustained over the longer term. Future programs should be rigorously evaluated through qualitative and quantitative analyses to generate conclusive evidence for best practice.

Accessing and navigating healthcare: A scoping review of the experiences of women of refugee background from Myanmar.

Despite well-documented health problems, healthcare access by women of refugee background in resettlement countries is typically poor. Suggested reasons include inadequate health literacy and resettlement challenges. A scoping review to explore the experiences of women of refugee background from Myanmar accessing and navigating healthcare was conducted following Arksey and O'Malley's framework, with an intersectional lens. Studies were analysed thematically following Braun and Clark's approach; four themes (eight subthemes) were constructed: Culture (Constructions of health; Navigating cultural tensions); Gender (Shifting gender roles; Sexual and reproductive health); Survivorship (Past health experiences; Strength in collectivism); and Language (The language barrier; Masked communication barriers). Intersectional factors of culture, gender, survivorship and language influenced women's experiences, shaping barriers and facilitators to healthcare. Community networks and bicultural peers are resources which may be enhanced. Research into trauma-informed cultural competency programs, community education and bicultural health navigators is recommended to support women of refugee background from Myanmar.

"You Have to Go Gently": Mentors' Perspectives of a Peer Mentoring Empowerment Program to Reduce Marginalization in Refugee and Migrant Women.

The Empowerment and Peer Mentoring of Migrant and Refugee Women pilot program (EMPOWER) provides a mechanism for migrant women who have established lives in Australia to mentor newly arrived women to build the ability, confidence, and knowledge to overcome barriers to the social determinants of health such as employment. Female migrant mentors (n = 21) met with their mentees (n = 32) on a regular basis over a period of 3 to 12 months between September 2019 and November 2021. The individual mentoring was augmented by group workshops facilitated by content experts and the research team. The unique perspectives of the mentors were explored through individual interviews (n = 15) and analysis of journal entries (n = 58) submitted regularly by mentors throughout the program. Thematic analysis revealed that mentors were intrinsically motivated to build strong and trusting connections with their mentees, which were pivotal to reducing inequalities for mentees and their families. Mentors had high expectations of themselves and demonstrated commitment and flexibility to accommodate mentees' needs. However, they sometimes struggled when supporting mentees who were overwhelmed by the systemic and other stressors associated with resettlement and pre-migration trauma. Regular networking and moral support for mentors would enhance future programs.

Seeking Health Information: A Qualitative Study of the Experiences of Women of Refugee Background from Myanmar in Perth, Western Australia.

Women of refugee background are subject to significant health inequity. Access to health information and a good level of health literacy are integral components to manage one's health needs. The aim of this study isto understand the experiences of women of refugee background from Myanmar seeking and accessing health information. Semi-structured interviews were conducted with 14 women of refugee background from Myanmar resettled in Western Australia. Interpretative phenomenological analysis underpinned the study and was conducted on the interview data. Three superordinate themes and nine subordinate themes emerged from the analysis: (1) Seeking health information (Motivation and Sources), (2) Facilitators and Barriers (Communication, Navigating the system and Community) and (3) Seeking health information in the context of past experiences (Health information as a by-product of healthcare, Health professionals' provision of health information, Accessibility of healthcare and Expectations on resettlement). These themes provide insight into the challenges of accessing understandable and actionable health information and of promoting the health literacy of women of refugee background from Myanmar. Co-designed community-based and health service interventions should be trialled, including trauma-informed training for health professionals, health information apps and community health promotion programs. Community engagement, participation and evaluation are critical for determining the effective interventions to address the inequalities experienced by this population.

Impact of a Pilot Peer-Mentoring Empowerment Program on Personal Well-Being for Migrant and Refugee Women in Western Australia.

The Empowerment and Peer Mentoring of Migrant and Refugee Women study (EMPOWER) examined the effectiveness of a participatory, peer mentoring program specifically tailored for migrant and refugee women to build ability, confidence, and knowledge to seek employment, a known contributor to mental health and wellbeing. Female migrant mentors (n = 21) supported five cohorts of mentees (n = 32), predominantly from Middle Eastern and Asian backgrounds, over a period of 3-12 months each between September 2019 and November 2021. The program consisted of both individual mentoring and group workshops facilitated by content experts and the research team. The mental health and wellbeing outcomes for the mentees were explored through individual interviews with both mentors and mentees. Results indicate the program helped participants develop social connections, self-esteem, self-efficacy, and personal health and safety skills. There are ongoing mental health needs in this cohort related to competing priorities and trauma. The development of trusting, respectful relationships with mentors who are committed and flexible is essential for positive wellbeing outcomes. Peer mentoring programs for migrant and refugee women can enhance mental health and wellbeing outcomes and facilitate independence. Mentors need resources to provide appropriate mental and physical health support for some groups.

Physical Activity Experiences of South Asian Migrant Women in Western Australia: Implications for Intervention Development.

The benefits of physical activity are widely recognised; however, physical activity uptake remains low in South Asian populations. South Asian migrant women face health risks as they adapt to new cultures, and these risks are often intensified through their limited participation in physical activity as one of the behaviours that promote positive health outcomes. Three focus group discussions with sixteen South Asian migrant women aged between 33 and 64 years, with a median age of 48 years and who live in Western Australia, were conducted. Thematic analysis of the transcribed qualitative data was completed to explore and uncover South Asian women's experiences with physical activity, as well as their motivation, beliefs, attitudes, and knowledge about physical activity. Five major themes emerged after coding and analysing the data. The themes included the women's knowledge of physical activity, their general attitudes and beliefs surrounding physical activity, the advantages and disadvantages of participation in physical activity, their experiences with physical activity, and the barriers, challenges, and facilitators surrounding physical activity. Recommendations are proposed to increase physical activity among this group to improve overall health and wellbeing and implications for intervention development are discussed.

The role of sport in coping and resilience amongst resettled South Sudanese youth in Australia.

In this article, the use of sport as a coping strategy by South Sudanese youth who have suffered the trauma of forced migration is examined. This article explores the relationship that has emerged between the young people and sport, in particular basketball, and how they use their participation in basketball and sports to cope with the stressors of their lives. The research intended to explore to what degree sport can play in improving mental health and what mental health interventions, in general, were being sought by this marginalized demographic. This qualitative study was underpinned by the psychosocial conceptual framework. We undertook semi-structured interviews with 23 South Sudanese youth aged 14-21 years, we also conducted focus groups of 11 South Sudanese elders and parents. The results of this research were feed back to the wider South Sudanese community through two forums. The data collected were analyzed using thematic analysis. The results of the study identified sport as an important coping strategy for the participants, both as a diversion from drug and alcohol misuse, potential criminal activity and as a way to self-manage the symptoms of anxiety and depression they were experiencing, and a mechanism to enhance self-worth. The study also indicated there was a lack of mental health interventions for these young people and that they had shown a great deal of resilience to develop their own ways to deal with the trauma they had experienced. The research reported positive associations of wellbeing and participation in sport, however more research needs to be conducted to ascertain the extent to which sport impacts mental health and how this can be incorporated into interventions for Sudanese youth and young people from similar forced migration and resettlement backgrounds. This study suggested that sport can be a driving force of good for many of the young people's lives, worthy of further research.

This article examined the use of sport as a coping strategy by South Sudanese youth in Melbourne, Australia who have suffered the trauma of forced migration. The study also explored the relationship between sport in particular basketball and how the youth use participation in sport as a strategy to cope with the stressors of their lives. The research used qualitative methods of in-depth semi-structured interviews, focus groups and community forums and was underpinned by the psychosocial conceptual framework. The data collected was analysed using thematic analysis. Semi-structured interviews were undertaken with youth aged 14 to 21 years and focus groups conducted with parents and community elders. The results from interview analysis were shared with the wider South Sudanese community through two community forums. Some themes drawn from the analysis included living with trauma, mental health and culture, racial discrimination and use of sport as a coping strategy. The findings also highlighted sport as a diversion from drug and alcohol misuse, potential criminal activity and as a mechanism to enhance self-worth. The study also indicated there was a lack of culturally appropriate mental health interventions for these young people and that they display a great deal of resilience to develop their own ways to deal with the trauma they had experienced. The research recommends further research to be conducted to identify the impacts of sport on mental health and how this can be incorporated into interventions for South Sudanese youth and young people from similar forced migration backgrounds.

Factors affecting utilization of health facilities for labour and childbirth: a case study from rural Uganda.

BACKGROUND: Since 2000 considerable attention has been placed on maternal health outcomes as the 5th Millennium Goal. In Uganda, only 65% of births are delivered by a skilled birth attendant, contributing to the 435 women that die in every 100,000 births from unattended complications. Factors that impact a women's decision on where to deliver include cost and household barriers, poor health services and lack of education. METHODS: Insight into factors impacting maternal health decision-making in two villages in South Eastern Uganda, were explored through a cross-sectional study using focus group discussions (FDGs) with men and women and administering a simple questionnaire. RESULTS: For men and women in the villages, cultural and community patterns of behavior have the strongest impact on delivery options. While women with no complications could often find options to deliver safely, lack of emergency obstetric care remains a strong factor in maternal deaths. CONCLUSIONS: This article proposes that communities be engaged in identifying and leveraging their strengths to find solutions for challenges facing women in achieving safe deliveries.

Medical abortion in Nepal: a qualitative study on women's experiences at safe abortion services and pharmacies.

BACKGROUND: Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country. METHODS: Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies. RESULTS: Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women's personal, social and economic empowerment. CONCLUSIONS: While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women.

Abortion in Nepal: perspectives of a cross-section of sexual and reproductive health and rights professionals.

BACKGROUND: Globally, women face many barriers in the attainment of sexual and reproductive health and rights (SRHR). Since 2002, the legalisation of abortion in Nepal has seen significant progress in the expansion of safe abortion and family planning services. METHODS: This qualitative, exploratory study was conducted in 2014 and uses nine in-depth, open-ended interviews with a cross-section of SRHR professionals, to explore their perspectives on abortion in Nepal. The study was underpinned by the Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology and used the health information pyramid conceptual framework. RESULTS: Thematic content analysis revealed emerging themes relating to barriers to access and uptake of skilled safe abortion services and post-abortion family planning. Findings also emphasised current practical and legal components relating to the provision of medical abortion through pharmacies and highlighted issues of sex-selective abortion within the predominantly patriarchal society. CONCLUSION: Effective and ongoing sector-wide monitoring and evaluation of safe abortion services and their staff is essential for women in Nepal to have adequate access to effective and efficient safe abortion services, access to contraception and sexual and reproductive health (SRH) information post-abortion and to ensure adherence to current Safe Abortion Policy. It is critical that the unsafe (less and least safe) provision of medical abortion through pharmacies and sex-selective abortion continues to be investigated and that innovative strategies are formulated to ensure the cultural, reproductive and sexual health and rights of Nepali women are realised.

One Year On: Cultural Competence of Australian Nursing Students Following International Service-Learning.

BACKGROUND: The effective delivery of health care to the growing multicultural population within Australia is a challenge for the nursing profession. A breakdown in cross-cultural communication and understanding, which stems from the tendency of nurses to project their own culturally specific values and behaviors onto patients and colleagues from other countries, can contribute significantly to non-compliance in migrant populations and conflict in collegial relationships. METHOD: The Inventory for Assessing the Process of Cultural Competence-Revised was administered to Australian undergraduate nursing students immediately before, immediately after, and 12 months after returning from international clinical placement. Data were analyzed using descriptive and inferential functions of SPSS. RESULTS: Overall cultural competence increased immediately following the placement and was sustained over time. However, there were significant differences among the five constructs measured. CONCLUSION: International clinical placements enhance cultural competence but targeted activities need to be undertaken pre-placement to develop specific aspects, in particular cultural desire. [J Nurs Educ. 2019;58(1):17-26.].

Something has shifted: Nursing students' global perspective following international clinical placements.

AIMS: To examine understandings of global health issues among nursing students following participation in an international clinical placement during their pre-registration university education. BACKGROUND: Universities use international clinical placements, especially in developing countries, to develop cultural awareness in students; however, little is known about the longer term influences on students' understandings of global nursing. DESIGN: A retrospective cross-sectional design was used, using an exploratory, descriptive qualitative approach. METHODS: Individual semi-structured interviews were conducted in 2014 with a purposive sample of 25 pre-registration nursing students from four Western Australian universities who undertook clinical placements across five countries. Data were analysed using inductive thematic analysis. RESULTS: Findings highlight that students developed new understandings around health systems including fragility of resource access, differences in clinical practice and variances in nursing roles between settings. Students also experienced challenges but were able to appreciate alternative world viewpoints. CONCLUSION: International clinical placements can develop greater awareness and help students form realistic strategies for using their nursing skills globally. Pre-placement training in cultural awareness and health system realities, along with strong supervisory support, is critical to success.

Access to contraception and sexual and reproductive health information post-abortion: a systematic review of literature from low- and middle-income countries.

AIM: This systematic literature review documented, analysed and critiqued the accessibility of contraception and sexual and reproductive health (SRH) information for women living in low- and middle-income countries who have undergone medical or surgical abortion. METHODOLOGY: This review systematically collated relevant and recent empirical evidence regarding women's access to contraception and SRH information post-abortion within low- and middle-income countries. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework Guidelines, Flow Diagram and Checklist were utilised to undertake the review. The Ovid (MEDLINE), ProQuest, Science Direct, Web of Science, PUBMED and CINAHL databases were searched and studies that met edibility criteria were assessed for validity and analysis. A narrative synthesis of characteristics and results of the included studies is presented. FINDINGS: After detailed assessment of available and relevant literature, nine studies were selected for inclusion in the review. Studies highlighted barriers to contraception and SRH information including supply limitation, lack of comprehensive education and counselling, lack of skilled post-abortion care (PAC) providers and abortion stigma. CONCLUSIONS: The review found that with access to a wide range of contraceptive methods combined with comprehensive SRH information and education, contraception uptake in women post-abortion does increase. The review also highlights the inconsistencies in clinic-reported 'counselling' and what this term actually involves within a PAC setting.